Hypercholesterolemia and cellular hyperproliferative disorders are causative factors in several different pathologies, many of which cause death. For example, hypercholesterolemia, also including hyperlipidemia for purposes of the present invention, is a contributing factor in the development of heart disease and stroke. Heart disease is the single biggest cause of death in the United States. Cellular hyperproliferative disorders include such diseases as psoriasis vulgaris, dysplastic skin diseases, pigmentary skin diseases, Kaposi's sarcoma; chronic adult respiratory syndrome, large granular lymphocyte/natural killer cell proliferative disease, haemopoietic proliferative disorders, B-cell proliferative disorders, pigmented villonodular synovitis, proliferative diseases of retinal cells, and some cancers. Although several of the cellular proliferative disorders only cause discomfort and patient suffering, several, such as cancer, may be fatal. In the United States alone, tens of thousands of people die from cancer each year, and additional tens of thousands suffer from the numerous other cellular hyperproliferative disorders.
High levels of blood cholesterol and blood lipids are conditions involved in the onset of arteriosclerosis. Arteriosclerosis is a major factor in the development of heart disease and stroke. Among the numerous studies into the origin of hyperlipidemia, and familiar hypercholesterolemia, various dietary components, such as, lipids, proteins, carbohydrates, dietary fibers, and trace metals, have been investigated. It is commonly assumed that plethoric diets high in fats and cholesterol are a major cause in the development of hypercholesterolemia. Moreover, plethoric diets are known to be associated with increased levels of low density lipoproteins (LDL), very low density lipoproteins (VLDL), and high density lipoproteins (HDL) (1,2).
Studies have shown that the incidence of coronary heart disease rises in linear fashion with the level of serum cholesterol. In the United States coronary heart disease kills many thousands of people annually. Because high serum cholesterol levels are directly related to coronary heart disease, reducing serum cholesterol levels is a major health concern in the United States.
Serum cholesterol levels that are generally accepted as within normal ranges in the United States are higher than those found among comparable individuals in populations with a low incidence of arteriosclerosis. The optimal serum cholesterol for a middle-aged American man is probably about 200 mg/100 ml, or less. For practical purposes, hypercholesterolemia is generally defined as any value above the 95th percentile for the population, which in Americans ranges from about 230 mg/100 ml in individuals less than 20 years old, to about 300 mg/100 ml in individuals greater than 60 years old. These limits are, however, probably excessive because of the known risk of cholesterol values at these levels. As an alternative method, practicing physicians frequently use a convenient rule of thumb which holds that any level of serum cholesterol greater than about 200 mg/100 ml plus the person's age should be considered abnormal. Even these limits may be too high.
Once a patient has been diagnosed as suffering from hypercholesterolemia the first, and most common, method of therapy is diet modification, e.g., the strict avoidance of the sources of cholesterol and saturated fats. The patient is instructed to avoid meat, especially organ meats and obviously fat, egg, whole milk, cream, butter, lard, and saturated cooking fats. These foods are replaced in the patient's diet with foods low in saturated fat and cholesterol, e.g., fish, vegetables, poultry, polyunsaturated oils, and margarine. However, because this therapy requires a dramatic lifestyle change and the substituted foods are generally less flavorful, patient compliance is very poor.
Once it is determined that dietary restrictions have not accomplished the desired end, pharmaceutical therapy is instituted. Hypocholesterolemic agents enjoy wide use and acceptance in the medical community as an alternative to dietary restrictions. Cholestyramine, a bile acid sequestrant, is a hypocholesterolemic agent which is effective in lowering serum cholesterol, especially when coupled with diet restrictions. A dosage of about 16 to about 32 grams in 2 to 4 divided daily doses will, for example, lower LDL levels by 25 to 50%, probably by increasing LDL removal. However, cholestyramine is associated with side effects, such as constipation and poor taste that limit general patient acceptance. Further, cholestyramine and another hypocholesterolemic drug, candicidin, apparently increased azoxymethanol-induced bowel tumorigenesis in the rat (3,4).
A further hypocholesterolemic agent, niacin is useful in hypercholesterolemia, but the high dosage required, three to nine grams per day in divided dosage with meals, coupled with the side effects of gastric irritability, hyperuricemia, hyperglycemia, flushing and pruritus, prevents its general use. Niacin is most effective when combined with cholestyramine.
Thyroid analogs, e.g., D-thyroxine, effectively lower LDL levels, but are contraindicated in patients with suspected or proven heart disease. Further, since these agents mimic thyroid hormone, they produce a plethora of untoward effects in the body. Accordingly, these agents have no little or no place in the therapy of the typical hypercholesterolemia patient. Other agents which are presently utilized are generally less effective than strict dietary management.
Heart disease kills tens of thousands of Americans every year. The major cause of heart disease is the accumulation of plaque in the coronary arteries. This accumulation is presumably cause by excessively high levels of serum cholesterol. However, there is still no effective hypocholesterolemic agent commercially available that has found wide patient acceptance.
In light of the enormity of this problem, it would be extremely advantageous to provide a hypocholesterolemic agent which effectively lowers serum cholesterol in a human without the attending side effects typically associated with previous hypocholesterolemic agents. Further, it would be advantageous to provide a hypocholesterolemic agent which is effective when administered to a patient in need thereof in a relatively small dose. Another and important advantage is realized by providing a hypocholesterolemic agent which is administered multiple times or once daily, particularly if a slow release formulation is used. It would also be advantageous to provide a hypocholesterolemic agent which is incorporated into a vehicle, such as a multivitamin and mineral tablet, and administered daily to the general population to prophylactically protect the population against hypercholesterolemia. A still further advantage would be realized in providing a hypocholesterolemic agent which is safely, and inexpensively added to foodstuffs intended for consumption by the general population, and thereby provide prophylactic protection against hypercholesterolemia.
Cellular hyperproliferative disorders are generally characterized by the hyperproliferation and incomplete differentiation of cells. For example, in psoriasis vulgaris there is a hyperproliferation of incompletely differentiated cells of the epidermis. Presently, it is not fully understood what causes certain cells to reproduce rapidly when the host has no apparent need for them. Since growing evidence suggests that cellular hyperproliferation is involved with chemically induced carcinogenesis, the inhibition of cellular proliferation may also be an effective tool for prevention of certain cancers. Accordingly, the inhibition of cellular proliferation may be an effective tool for preventing psoriasis vulgaris, dysplastic skin diseases, pigmentary skin diseases, Kaposi's sarcoma and several other diseases associated with the hyperproliferation of cells such as chronic adult respiratory syndrome, large granular lymphocyte/natural killer cell proliferative disease, haemopoietic proliferative disorders, B-cell proliferative disorders, pigmented villonodular synovitis, or hairy cell leukemia, or proliferative diseases of retinal cells, for example. In light of the relation between the hyperproliferation of cells and several diseases, it would be extremely advantageous to provide an antiproliferation agent which effectively inhibits cellular hyperproliferation in a human with little or no side effects. Further, it would be beneficial to have an antiproliferative agent which is effective when administered to a patient in need thereof in a relatively small dose. Another and important advantage is realized by providing an antiproliferative agent which may be administered once daily. It would also be advantageous to provide an antiproliferative agent which is incorporated into a vehicle, such as a multivitamin and mineral tablet, and administered daily to the general population to prophylactically protect the population against cellular hyperproliferation. A still further advantage would be realized in providing an antiproliferative agent which is safely, and inexpensively added to foodstuffs intended for consumption by the general population, and thereby provide prophylactic protection against the disease typically associated the with hyperproliferation of cells.
Considering the morbidity and mortality created by both of the above condition, i.e., hypercholesterolemia, and the hyperproliferation of cells, it would be extremely advantageous to provide one agent which prevented or treated both conditions simultaneously. Further, since both conditions affect the general population, it would be advantageous to provide a sustained release preparation, such as a multivitamin and mineral tablet which could be administered to prevent these conditions in the general populations. It would also be of benefit to provide a multivitamin and mineral preparation which contained agents which acted synergistically to prevent or treat hypercholesterolemia and the hyperproliferation of cells.